Hypertension is a major independent risk factor for coronary artery disease, stroke, heart failure and chronic kidney failure. In many regions of the world, there are a lot of people who have high blood pressure. Even in the United States, out of every three adults, one is hypertensive. If this number is expressed as a percentage, then the prevalence of hypertension in the United States is around 30%. More than just a large number, the impact of hypertension is frightening, both in terms of morbidity and mortality. According to reports, hypertension alone was responsible for 18% of cardiovascular disease mortality in western nations. The impact to the state financial losses is also enormous. The state is said to lose 47.5 billion dollars annually. Thus, it makes sense to be aware of hypertension from the beginning, and it also makes sense to start an early detection program as soon as hypertension is identified in order to lower the incidence of hypertension and its sequelae. We at least perform one of the procedures, like routine blood pressure checks in accordance with the clinical circumstances.

Prehypertension as a warning

The question is, what is prehypertension? Why is prehypertension a problem? According to JNC 8 (Joint National Committee), hypertension is classified into prehypertension, stage 1 hypertension, and stage 2 hypertension. If a prehypertensive person does not behave as their doctors have suggested to instantly modify their habits and lifestyle, they may experience a chronic high blood pressure. If he does not do it, he will probably get severe high blood pressure, which can lead to complications like dementia, renal disease, blindness, heart disease, and stroke. He will generally need to take prescription medications for the rest of his life. It is the progression of prehypertension into hypertension, along with all of the related consequences. To prevent hypertension and its problems, those with prehypertension should be advised to recognize it as soon as possible.

The prehypertension rate is more than 120/80 to 139/89 mmHg (systolic/diastolic). The figures are based on at least two properly seated blood pressure readings taken at each of at least two clinic appointments. Systolic and diastolic numbers that fall into separate categories are applied, together with the category corresponding to pressures greater than 2. One should take this blood pressure number seriously as a warning. These values indicate prehypertension, which eventually results in hypertension and all of its problems. As a result, planning ahead is essential to avoiding prehypertension. Alternatively, if prehypertension already exists, the development to hypertension should be stopped. "Never underestimate hypertension" refers to such condition.

In reality, healthy adults should have their blood pressure measured annually, beginning with young adults (often above the age of 18). If he receives an abnormal reading, he needs to undergo periodic and more frequent examinations under the care of a family physician. Because the majority of people can appear to be in excellent health but yet have blood pressure readings too high, routine blood pressure examinations are crucial. Readings beyond 120/80 mmHg already constitute a warning. Such readings have even indicated prehypertension. Additionally, for the majority of adults, hypertension is regarded as existing when the reading starts at 140/90 mmHg or higher. Prehypertension, which is typically prevalent in young adults, is still present if the upper numbers (systolic) are between 120 and 139 mmHg and/or the lower numbers (diastolic) are between 80 and 89 mmHg. What about older people? For people over the age of 50, the systolic reading is actually more important than the diastolic reading. If the systolic pressure is 120 or higher, one should prioritize making lifestyle changes that can lower blood pressure such as losing weight, eating a low-salt diet, and exercising frequently. One needs to consult the closest medical professional about his targeted blood pressure level, potential medication needs, and necessary lifestyle modifications. Within a month from the beginning of the therapy, controlled blood pressure goals are typically reached by either raising the original drug dose or by utilizing a combination of medications supported by a healthy lifestyle. The new recommendations state that the target for controllable blood pressure in patients with kidney disease and hypertension is <140/90 mmHg, whereas in patients with diabetes and hypertension it is conservatively advised to be nearly the same or even lower if there is severe protein leakage in the urine.

If you have prehypertension, never waste your time until it progresses to higher blood pressure. Do something. According to the Dietary Approaches to Stop Hypertension (DASH), appropriate lifestyle changes play a strategic role in helping delay the development of high blood pressure and the need for medication. The lifestyle changes referred to are as follows:

• For those who are physically able, engage in aerobic activity for at least 30 minutes each day. Walk frequently and flexibly, depending on your physical capabilities. All of these have been demonstrated to assist in lowering blood pressure while also assisting in maintaining a healthy weight.
• Consume foods high in fiber, such as fresh fruits and vegetables, whole grains, and low-fat dairy products.
• Reduce salt (sodium) intake to less than 2.4 grams of sodium per day. The American Heart Association recommends consuming no more than that.
• Avoid alcohol or, if not, limit alcohol intake to 2 small glasses (shots) a day.
• Quit smoking. In addition to contribute in controlling blood pressure, it can also reduce cardiovascular risk.
• Avoid stress, for example by mastering relaxation techniques.
• Adequate sleep (with a duration of 6-8 hours per day)

It is clear that the phrase "never underestimate hypertension" is not being overused to warn people who may develop the condition. It should also be a concern for all of us, and one way to show this is to regularly check our blood pressure as advised by health professionals. (*)

Djoko Santoso
Professor, Faculty of Medicine, Universitas Airlangga
Chairman of Health Department, Indonesian Council of Ulama, East Java